• PTO/SB/06 (08-03)
Approved for use through 7/31/2006. OMB 0651-0032
PATENT APPLICATION FEE DETERMINATION RECORD
Substitute for Form PTO-875
AppljpaUoo or Docket Number
CLAIMS AS FILED - PART I
(Column 1) (Column 2)
FOR
BASIC FEE
(37 CFR 1.16(a))
TOTAL CLAIMS
(37 CFR 1.16(c))
INDEPENDENT CLAIMS
(37 CFR 1.16(b))
NUMBER FILED
NUMBER EXTRA
minus 20 >
2_
MULTIPLE DEPENDENT CLAIM PRESENT
(37 CFR 1.16(d))
' If the difference in column 1 is less than zero, enter "0" in column 2.
CLAIMS AS AMENDED - PART II
(Column 1)
LU
Q
2:
LU
<
Total
(37 CFR 1.16(c))
Independent
(37 CFR 1.16(b))
(Column 2) (Column 3)
CLAIMS
REMAINING
AFTER
AMENDMENT
2l
Minus
Minus
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
13.
PRESENT
EXT|
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM (37 CFR 1.16(A)
(Column 1)
ENTB
| CLAIMS
REMAINING
AFTER
AMENDMENT
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
in mi
lUMI
Total
(37 CFR 1.16(c))
Minus
vipm
Independent
(37 CFR 1.16(b))
Minus
I <
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM (37 CF
R 1.16(d))
(Column 1)
(Column 2)
(Column 3)
ENTC
CLAIMS
REMAINING
AFTER
AMENDMENT
HIGHEST
, NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
DMI
Total
(37 CFR 1 .16(c))
Minus
**
4EN
Independent
(37 CFR 1.16(b))
Minus
<
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM (37 CFF
X 1.16(d))
SMALL ENTITY
OR
OTHER THAN
SMALL ENTITY
RATE
FEE
RATE
FEE
%
OR
X $_ =
OR
X $ =
X $ =
OR
X $ =
+ $_
OR
+ $
TOTAL
OR
TOTAL
SMALL
ENTITY
OTHEf
SMALL
^THAN
ENTITY
RATE
ADDI- /
TIONAL !
FEE
RATE
ADDI-
TIONAL
FEE
X $ =
OR
X $
X $
OR
X $ =
+ $
OR
+ $
TOTAL
ADD! FEE
OR
TOTAL
ADD'L FEE
RATE
ADDI-
TIONAL
FEE
RATE
ADDI-
TIONAL
FEE
X $ =
OR
X $
X $
OR
X $ =
+ $
OR .
+ $
TOTAL
ADD'L FEE
OR
TOTAL
ADD'L FEE
RATE
ADDI-
TIONAL
FEE
RATE
ADDI-
TIONAL
FEE
X $ ' =
OR
X % =
X $ =
OR
X $ =
+ $
OR J
+ $
TOTAL
ADD'L FEE
OR
TOTAL
ADD'L FEE
• If the entry in column 1 Is less than the entry In column 2, write "0" In column 3
JT Jf.? e 3 hest Number Previous, y Paid Fof IN THIS SPACE Is less than 20, enter "20".
If the Highest Number Previously Paid For* IN THIS SPACE Is less than 3, enter "3"
The -Highest Number Previously Paid For (Total or I ndependent) is the highest number found in the appropriat e box in column 1
Oection of information k romilroH hu 17 rep 4 4c t>.Ji,i i >_ , . . ■.' ' _ . 1 '•
hS™ f* 10 " ° f i ? f0rmati ?, n ' s re q uired °y 37 CF * 1-16. The information is required t o obtain or retain a benefit by the public which is to file ranH h v m»
ADDRESS. SEND TO: Commissioner for Patents, P.O. Box 1450, Alexandria, VA 22313-1450. vAJMrLt I tu l-ORMS TO THIS
If you need assistance in completing the form, call U800-PTO-91 99 and select option 2.
PATENT APPLICATION FEE DETE RMINATION RE COKU I aSL° ~ OMB " 1 "" nl
Substitute for font, PTO-afc I "Pulton or
APPLICATION AS FILED - PARTI
FOR
NUMBER FILED .
NUMBER EXTRA
BASCFEE
SEARCH REE
(37 CFR 1.16(H). <D»«f(m»
EXAMINATION FEE
(37CFR1.16fo).<p),or«i/
TOTAL CLAIMS
(37 CFR I.Wn)
: minus 20 =
• minus 3 °
I APPUCATDN SIZE
1 07CFR1.16(s))
If the specification and drawings exceed 100
eheets of paper, the application eke fee due
te $250 ($125 for small entity) for each
additional 50 eheets or fraction thereof. See
35 U.S.C. jlfaKIHG) and 37 CFR 1 iRte,
MULTIPLE DEPENDENT CLAIM PRESENT (37 CFR 1.18Q»
SMALL ENTITY OR
APPLICATION AS AMENDED - PART II
RATEttl
-ESI .
X a
X =
TOTAL
. OTHER THAN
SMALL ENTITY
, RATE ffj
OR
TOTAL
(Column 1)
*
5
CLAIMS
REMAINING
AFTER
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
LLf
2
r\
Total
P 1 * CFR 1.1640
A^^IENr
Minus
s
ENC
OTchM.Kfcfl
Minus
' <
Application Stze Fee (37 CFR 1.16(a)) V '
FIRST PRESQfTATION OF MUtTtPU=0£P©^Kr CLAiM (37 CFt
SMALL ENTITY
OR
(Column 1)
y
CLAIMS
REMAINING
AFTER
AMENDMENT
HIGHEST
NUMBER
PREVIOUSLY
PA© FOR
PRI
FJ
iSENT
TRA '
I s
Total
Minus
s
. Mmus
s
r
Application btte Fee (37 CFR 1. 16(s» *-* ~
FWSTPRESENTATION OF WUIT7PUE PGPB^Oerr CUUM (37CFRIli©)
RATE ($)
ADDI-
TIONAL
FEE <$)
r—
I
m
TOTAt
A0D1FEE
OTHER THAN
SMALL ENTTTY
OR
TOTAL
°R ADOXFEE
- I IE S^lf'T 1 ^^tfieer^mcdixmn2 f wrtteVfri column 3
- SZ^^S^SS^S^ For fN THK? ^ACE b lesTtnan™ enter W
RATE ($)
AC
TO
FEf
F
X e
* ?
TOTAL
ADOLFEE
OR
OR
OR
OR
RATEfl)
Add*-
PONAL 1
X B
X B
TOTAL
ADO! FEE
ADDRESS. SEND TO: Commlsstoner for Patent*. P.O. Bo? 1450.XMnSa! VA^3^^. eN0FffiS ^ OOMPLETE0 «*Me TO ?m
'Ow^a^ancerncompfe^^